OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT FACILITIES DEVELOPMENT … OFFICE OF STATEWIDE...

“Access to Safe, Quality Healthcare Environments that Meet California’s Diverse and Dynamic Needs”

OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT

FACILITIES DEVELOPMENT DIVISION

STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY

OSH-FD-OPAA-100 (6/24/2016) 7/25/2017 OPAA-0012-16 of 19

APPLICATION FOR OSHPD PREAPPROVED AGENCY (OPAA) FOR STRUCTURAL TESTS AND SPECIAL INSPECTIONS

For Office Use Only

OPAA-0012-16 Approved Agency City County State ZIP Code

SCST, Inc. San Diego San Diego CA 92120

APPLICATION TYPE / FEE

Application Type New Application Fee

(Fees are Nonrefundable) Renewal Fee

(Fees are Nonrefundable)

☒Combined Testing AND Special Inspection Agency ☐$1,000.00 ☒$250.00

☐Testing Agency ONLY ☐$500.00 ☐$250.00

☐Special Inspection Agency ONLY ☐$500.00 ☐$250.00

APPLICANT INFORMATION Applicant Name

Ron Baudour Position in the Organization

Director of Field Services Agency’s Local Name

SCST, Inc. Application Date

July 17, 2017 Phone Number

619.280.4321 ext. 232 E-Mail

[email protected]

Applicant certifies that all information provided in this application are accurate. Applicant Signature

Address of Facility Location (Each facility location requires separate application.)

Street

6280 Riverdale Street City:

San Diego County

San Diego State:

CA Zip Code:

92120 Facility Mailing Address (If different from facility address above.)

Street

City: State: Zip Code:

KEY AGENCY PERSONNEL (Attach additional pages if needed.) Engineering Manager (or equivalent) – Name

Emil Rudolph CA Registration Number

Civil #64301; GE #2767 Expiration Date

June 30, 2019 Title in the Organization

Vice President of Operations Phone Number 619.280.4321 ext. 209

FAX Number 619.528.4717 E-Mail [email protected]

Alternate to Engineering Manager (if any) – Name

Thomas Canady CA Registration Number

Civil #50057Expiration Date

June 30, 2019Title in the Organization

Principal Engineer Phone Number

619.280.4321 ext. 266 Alternate Phone Number

619.944.4019 (mobile) E-mail

[email protected]






KEY TESTING PERSONNEL (Attach additional pages if needed.)

Testing Supervisor – Name

Clint Adkins CA Registration Number (if any)

N/A Expiration Date

Title in the Organization

Director of Laboratory Services Phone Number


714.321.6029 (mobile) E-Mail

[email protected] Field Testing Supervisor – Name

Sam Carbajal CA Registration Number (if any) Expiration Date


Special Inspector Phone Number

619.253.3420 Alternate Phone Number E-mail

[email protected]

KEY SPECIAL INSPECTIONS PERSONNEL (Attach additional pages if needed.)

Special Inspections Supervisor – Name

Ron Baudour CA Registration Number (if any)

N/A Expiration Date


Director of Field Services Phone Number


619.944.4020 (mobile) E-Mail

[email protected]

Field Special Inspection Supervisor – Name

Sam Carbajal CA Registration Number (if any) Expiration Date


Special Inspector

Phone Number

619.253.3420

Alternate Phone Number E-mail

[email protected]






ACCREDITATION AND QUALIFICATIONS

Agency currently holds accreditation by: (Attach a copy of current accreditation details.)

☒ AASHTO Accreditation Program (AAP) ☐ National Voluntary Laboratory Accreditation Program (NVLAP)

☐ International Accreditation Service (IAS) ☐ American Association of Laboratories Program (A2LA) ☐ Laboratory Accreditation Program (LAB) ☐ Construction Materials Engineering Council (CMEC)

☐ ANSI-ASQ National Accreditation Board ☐

Other

Latest Expiration Date (if any) N/A

Is this Agency accepted in the Division of the State Architect Laboratory Evaluation and Acceptance Program, DSA-LEA?

☐ No ☒ Yes Expiration Date: April 25, 2021

Basis for accreditation (Check all that apply):

☐ ISO/IEC 17025: General requirements for competence of testing and calibration laboratories

☐ ISO/IEC 17020: General requirements for the operation of various types of bodies performing inspection

☐ NISTIR 7012: Technical requirements for construction materials testing

☒ AASHTO R18: Standard Recommended Practice for Establishing and Implementing a Quality System for Construction Materials Testing Laboratories

☒ ASTM E 329: Specification for Agencies Engaged in the Testing and/or Inspection of Materials Used in Construction

☒ ASTM C 1077: Practice for Laboratories Testing Concrete and Concrete Aggregates for Use in Construction and Criteria for Laboratory Evaluation

☒ ASTM D 3666: Specification for Minimum Requirements for Agencies Testing and Inspecting Bituminous Paving Materials

☒ ASTM D 3740: Practice for Evaluation of Agencies Engaged in Testing and/or Inspections of Soils and Rock as Used Engineering Design and Construction

☒ ASTM C 1093: Practice for Accreditation of Testing Agencies for Unit Masonry

☐ ASTM E 1212: Practice for Quality Management Systems for Nondestructive Testing (NDT) Agencies ASTM E 543: Specification for Agencies Performing Nondestructive Testing (NDT) IAS AC 291: Accreditation Criteria for Special Inspection Agency

Basis for Test Technician/Special Inspector Qualification (Check all that apply):

☐ Hospital inspector class “A”, “B”, or “C” certification

☒ DSA-LEA approval as test Technician/special inspector

☐ Certification listed in IAS AC 291 Table 1: Minimum Qualifications for Special Inspectors

☒ Welding inspectors satisfying the requirements of the CBC 2016 Section 1705A.2.5

☐ California licensed engineer qualified to be test technician/special inspector






APPLICABLE TEST STANDARDS FOR WHICH AGENCY IS APPROVED

By checking “yes” in Tables 1 through 6 below, the applicant verifies that the agency has the equipment and qualified personnel to perform the indicated testing. ONLY mark tests that are listed in accreditation certificate or DSA-LEA.

1 SOILS AND FOUNDATIONS

Tests Yes Standard Test Procedure Yes Standard Test Procedure

☒ a. ASTM D 421 Dry Prep of Soil ☒ b. ASTM D 422 Particle Size Analysts

☐ c. ASTM D 558 Moisture Density of Soil Cement Mixtures ☒ d. ASTM D 698 Compaction of Soil-Standard

☐ e. ASTM D 854 Specific Gravity of Soil ☒ f. ASTM D 1140 No. 200 Wash ☐ g. ASTM D 1143 Deep Foundations – Axial Compression ☒ h. ASTM D 1556 Density of Soils – Sand Cone

☒ i. ASTM D 1557 Soil Compaction – Modified ☐ j. ASTM D 1883 CBR Lab. Compacted Soils

☐ k. ASTM D 2166

Unconfined Compressive Strength/Moisture content

☒ I. ASTM D 2216 Water Content of Soil

☒ m. ASTM D 2419 Sand Equivalent Value ☐ n. ASTM D 2434 Permeability of Granular Soils ☐ o. ASTM D 2435 Consolidation Test ☒ p. ASTM D 2487 Classification of Soils ☒ q. ASTM D 2488 Identification of Soil (Visual) ☒ r. ASTM D 2844 Resistance R-Value & Exp. Pressure ☐ s. ASTM D 2850 Unconsolidated, Undrained Triaxial ☐ t. ASTM D 2974 Organic Content ☐ u. ASTM D 3080 Direct Shear ☐ v. ASTM D 3441 Cone Penetration Test (CPT) ☐ w. ASTM D 3689 Deep Foundations – Axial Tension ☐ x. ASTM D 3744 Durability Index ☐ y. ASTM D 3966 Deep Foundations –Lateral Loads ☒ z. ASTM D 4318 Liquid I Plastic Limit

☐ aa. ASTM D 4546 Swell or Collapse Test ☐ bb. ASTM D 4643 Microwave Moisture of Soils

☐ cc. ASTM D 4718 Oversize Rock Correction ☐ dd. ASTM D 4767 Triaxial Compression

☐ ee. ASTM D 4829 Expansion Index ☐ ff. ASTM D 4945 Deep Foundations – Dynamic Testing

☐ gg. ASTM D 5084 Permeability of Soils ☐ hh. ASTM D 5778 Friction Cone and Piezocone Penetration Test

☐ ii. ASTM D 6913 Gradation of Soil Using Sieve Analysis

☒ jj. ASTM D 6938 Density of Soils – Nuclear Gage

☐ kk. ASTM D 7012

Triaxial Compressive Strength of Rock Core Specimens

☐ ll.

☐ mm. ☐ nn.

Tests that are in the lab’s scope but are not listed above should be provided in the space(s) below.

Yes Standard Test Procedure Yes Standard Test Procedure ☐ a. ☐ b. ☐ c. ☐ d. ☐ e. ☐ f.






2 CONCRETE

Tests

Yes Standard Test Procedure Yes Standard Test Procedure

☐ a. AASHTO M 201 Moisture Rooms ☐ b. ACI 355.2 Post-Installed Mechanical Anchors

☐ c. ACI 355.4 Adhesive Anchors ☐ d. ACI 374.1 Moment Frames

☐ e. ACI ITG-5.1 Post-Tensioned Precast Special Walls ☐ f. ASTM A 416 Steel Strand

☒ g. ASTM A 615 Tension Test ☐ h. ASTM A 706 Tension and Bend ☐ i. ASTM A 970 Headed Steel Bars - Bend ☐ j. ASTM A 1034 Rebar Mechanical Splices

☒ k. ASTM C 29 Unit Weight I Voids ☒ I. ASTM C 31 Concrete Sampling - Field

☒ m. ASTM C 39 Compressive Strength ☒ n. ASTM C 40 Organic Impurities

☒ o. ASTM C 42 Concrete Core ☒ p. ASTM C 78 Flexural Strength ☐ q. ASTM C 88 Sodium Sulfate Soundness ☒ r. ASTM C 117 No. 200 Wash ☒ s. ASTM C 127 Specific Gravity - Coarse ☒ t. ASTM C 128 Specific Gravity - Fine ☒ u. ASTM C 131 Degradation of Aggregate ☒ v. ASTM C 136 Sieve Analysis Course I Fine ☒ w. ASTM C 138 Density I Yield I Air Content ☐ x. ASTM C 142 Clay I Friable Particles ☒ y. ASTM C 143 Slump ☒ z. ASTM C 157 Length Change ☒ aa. ASTM C 172 Sampling Freshly Mixed Concrete ☒ bb. ASTM C 173 Air Content (V)

☐ cc. ASTM C 174 Measuring Thickness Using Drilled Concrete Cores ☒ dd. ASTM C 192 Making I Curing Specimens - Lab

☒ ee. ASTM C 231 Air Content (P) ☐ ff. ASTM C 295 Petrographic Analysis ☒ gg. ASTM C 495 Lightweight Concrete ☒ hh. ASTM C 496 Splitting Tensile ☒ ii. ASTM C 511 Moist Cure Rooms/Tanks ☐ jj. ASTM C 535 LA Abrasion ☒ kk. ASTM C 566 Moisture Content of Aggregate ☐ ll. ASTM C 567 Density of Lightweight Aggregate

☒ mm. ASTM C 617 Capping Concrete Specimens ☒ nn. ASTM C 702 Reducing Aggregate Samples

☒ oo. ASTM C 1064 Temperature ☐ pp. ASTM C 1140 Shotcrete Compression

☒ qq. ASTM C 1231 Unbonded Caps ☒ rr. ASTM C 1252 Uncompacted Void Content

☐ ss. ASTM C 1260 Alkali Reactivity of Aggregate

☐ tt. ASTM C 1293 Length Change due to Alkali-Silica Reaction

☐ uu. ASTM C 1542 Measuring Length of Cores ☐ vv. ASTM C 1602 Water

☐ ww. ASTM C 1604 Shotcrete Core ☒ xx. ASTM D 75 Sampling Aggregate

☒ yy. ASTM D 1560 Stabilometer Value ☒ zz. ASTM D 1561 Prep for HMA Test Specimens

☒ aaa. ASTM D 2041 Maximum Theo. Specific Gravity ☒ bbb. ASTM D 2419 Sand Equivalent Value

☒ ccc. ASTM D 2726 Specific Gravity of Marshall Sample ☒ ddd. ASTM D 2950 In-Situ Density with Nuc. Gauge

☐ eee. ASTM D 3039 Tensile Strength of FRP ☒ fff. ASTM D 3203 Percent Air Voids

☐ ggg. ASTM D 3744 Aggregate Durability Index ☐ hhh. ASTM D 4541 Pull of Strength of FRP

☒ iii. ASTM D 4791 Flat Elongated Pieces in Aggregate

☒ jjj. ASTM D 5444 Sieve Analysis of Extracted Aggregate

☒ kkk. ASTM D 5821 Percent Crushed Particles ☒ lll. ASTM D 6307 Asphalt Content by Ignition

☒ mmm. ASTM D 6926 Prep for Marshal test Specimen ☒ nnn. ASTM D 6927 Marshall Stability & Flow, Air Voids






2 CONCRETE (Continued)

Tests


☐ ooo. ASTM E 488 Strength of Anchors ☐ ppp. ASTM E 1190 Power Actuated Fasteners

☐ qqq. ASTM E 1512 Bond Strength of Anchors ☐ rrr. ICC-ES AC 193 Anchors in Concrete

☐ sss. ICC-ES AC 232 Anchor Channels in Concrete ☐ ttt. ICC-ES AC 308 Adhesive Anchors in Concrete

☐ uuu. ICC-ES AC 395 Headed Shear Stud Reinforcement ☐ vvv.

ICC-ES AC 398 Cold Formed Steel Connectors in Concrete for Light-Frame Construction

☐ www. ICC-ES AC 399 Cast-in-Place Bolts in Concrete for Light-Frame Construction

☐ xxx.

☐ yyy. ☐ zzz.

Tests that are in the lab’s scope but are not listed above should be provided in the space(s) below. Yes Standard Test Procedure Yes Standard Test Procedure ☐ a. ☐ b. ☐ c. ☐ d. ☐ e. ☐ f.






3 MASONRY

Tests Yes Standard/Code Reference Test Procedure Yes Standard/Code Reference Test Procedure ☒ a. ASTM C 39 Core Compressive Strength ☐ b. ☒

c. ASTM C 140 Absorption, Compressive Strength, Unit Weight, Dimensions & Moisture Content

☐ d.

☐ e. ASTM C 426 Linear Drying Shrinkage ☒ f. ASTM C 780 Mortar Compressive Strength

☒ g. ASTM C 1019

Sampling and Testing Grout (Compressive Strength)

☒ h. ASTM C 1314

Prism Sampling & Compressive Strength

☐ i. ☒ j. ASTM C 1552 Capping Masonry ☐ k. ASTM E 384 Micro-indentation Hardness ☐ l.

☒ m. CBC 2105A Mortar Sampling ☒ n. CBC 2105A Core Shear

☐ o. ICC-ES AC 01 Anchor in Masonry ☐ p. ICC-ES AC 58 Adhesive Anchors

☐ q. ICC-ES AC 106 Screw Anchors in Masonry ☐ r.

☐ s. ☐ t.


Yes Standard/Code Reference Test Procedure Yes Standard/Code Reference Test Procedure

☒ a. ASTM C42 Drilled Cores Sampling ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.






4 STEEL

Tests


☐ a. AISC 341 Section K2 Beam to Column Moment & EBF Connections Cyclic Tests ☐ b. AISC 341 Section K3 BRBF Cyclic Tests

☐ c. ASTM A 90 Weight of Coating ☐ d. ☒ e. ASTM A 370 Tension & Bend Test ☐ f. ASTM A 970 Headed Steel Bars Bend Test ☐ g. ASTM A 1061 Uncoated Seven-Wire Tension ☐ h. ASTM A 1064 Steel Wire Tension & Bend Test

☐ i. ASTM E 10 Brinell Hardness ☒ j. ASTM E 18 Rockwell Hardness ☐ k. ASTM E 23 Charpy V - Notch ☐ l. ASTM E 94 Radiographic ☒ m. ASTM E 164 Ultrasonic ☐ n. ASTM E 165 Liquid Penetrant

☐ o. ASTM E 190 Guided Bend ☒ p. ASTM E 290 Bend Test ☒ q. ASTM E 605 Density of SFRM ☒ r. ASTM E 1444 Magnetic Particle

☒ s. ASTM F 606 Bolt Tension Test ☒ t. CBC 2203A Material Identification

☐ u. ICC-ES AC 318 Tapping Screw Fasteners ☐ v. ICC-ES AC 322 Cold-formed Steel Vertical Assemblies

Tests that are in the lab’s scope but are not listed above should be provided in the space(s) below. Yes Standard/Code Reference Test Procedure Yes Standard/Code Reference Test Procedure ☒ a. ASTM A615 Reinforcing Steel Bend/Tensile ☐ b. ☒ c. ASTM E736 Cohesion/Adhesion of SFRM ☐ d. ☐ e. ☐ f.

5 Wood and Roof Assemblies

Tests


☐ a. ASTM C 67 Brick and Structural Clay Roof Tiles ☐ b. ASTM D 1761 Fasteners in Wood

☐ c. ASTM D 2395 Density/Sp. Gr. Of Wood ☐ d. ASTM D 3617 Analysis of Built-Up Roof Systems

☐ e. ASTM D 4442 Moisture Content of Wood ☐ f. ASTM D 7147 Joist Hangers ☐ g. ASTM E 72 Panel Testing ☐ h. ASTM E 2126 Cyclic Testing of Panel for Shear

☐ i. ICC-ES AC 130 Wood Shear Panels ☐ j. ICC-ES AC 155 Hold-Down for Woods

☐ k. ICC-ES AC 233 Alternate Dowel-Type Threaded Fasteners ☐ l. ICC-ES AC 283 Plate Connector for Wood Trusses

☐ m. ☐ n.


☐ a. ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.






6 COMPONENT, ASSEMBLY, PROTOTYPE & MISCELLANEOUS TESTING

Tests


☐ a. AAMA 501.4 Static Test for Curtain Wall and Storefront Systems ☐ b. AAMA 501.6 Dynamic Test for Curtain Wall

and Storefront Systems

☐ c. ICC-ES AC 156 Shake Table Test ☐ d. FM 1950 Seismic Sway Brace Testing

☐ e. ☐ f.

☐ g. ☐ h.

☐ i. ☐ j.

Tests that are in the lab’s scope but are not listed above should be provided in the space(s) below. ☐ a. ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.






7 TEST TECHNICIANS

Provide Following Information for Each Test Technician Employed by the Agency (Attach additional sheets if needed)

*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required Fi ld d T f I ti

Test Technician’s Name

Certification/ License Type

Certification/ Licensing Agency

Certification/ License Number Expiration Date* Comments

Darren Hicks

Concrete Field ACI 01152495 02-08-19 Concrete Laboratory 12-12-20 Aggregate 12-12-20 Concrete Strength 12-12-20 Nuclear Gauge ATI N/A N/A

Raul Tena

Concrete Field ACI 01273862 08-11-23 Concrete Laboratory Aggregate Concrete Strength Nuclear Gauge APNGA N/A

Carlos Madrid Concrete Field ACI 01304779 10-18-19

Joseph Urrete Concrete Field ACI 00036795 03-19-21

John Carr Concrete Field ACI 00077917 04-16-21

Samuel Carbajal Concrete Field ACI 00103859 06-17-22

Gary Pitonyak Concrete Field ACI 00997822 03-08-19

James Allen Concrete Field ACO 01079664 12-12-20 Nuclear Gauge CPN International 45801 N/A

Darron Bauer Concrete Field ACI 01234229 12-10-21

Stephen Braun Concrete Field ACI 01000558 04-21-23

Clint Adkins Concrete Field ACI 01049477 09-26-20 Concrete Laboratory 09-26-20 Aggregate 09-26-20

Andrew Molina Concrete Field ACI 00005534 08-11-23

Duc Nguyen Ultrasonic Level I NPCS N/A N/A Ultrasonic Level II NPCS N/A N/A Magnetic Particle I & II CTE N/A N/A

Michael Flowers Nuclear Gauge CPN International 40275 N/A

Brad Chitwood Nuclear Gauge CPN International 39470 N/A Concrete Field ACI 00119748 08-11-2023

Daniel Ferguson Nuclear Gauge Troxler 069409 N/A Concrete Field ACI 00972642 02-10-23

Test Technicians with expired license shall not be permitted to perform Tests.






7 TEST TECHNICIANS (Continued)



Test Technician’s Name




Tyler Garrison Nuclear Gauge APNGA N/A N/A Concrete Field ACI 01269929 04-21-23

Ismael Gonzalez Nuclear Gauge CPN International 32715 N/A Concrete Field ACI 01108924 08-12-22

Adam Thomas Nuclear Gauge CPN International 44870 N/A Concrete Field ACI 105465 08-04-23

Christopher Wilson Nuclear Gauge CPN International 12496 N/A







APPLICABLE SPECIAL INSPECTIONS FOR WHICH AGENCY IS APPROVED

By checking “yes” in Tables 7 through 12 below, the applicant verifies that the agency has the equipment and qualified personnel to perform the indicated special inspections. ONLY mark tests that are listed in accreditation certificate or DSA-LEA.

8 SOILS AND FOUNDATIONS

Special Inspections

Yes Code/Standard Field and Types of Inspection Yes Code/Standard Field and Types of Inspection

☒ a. CBC 1705/1705A Cast-in-place Deep Foundations ☒ b. CBC 1705/1705A Driven Deep Foundations

☒ c. CBC 1705/1705A Soils (Excavations and Fills) ☒ d. CBC 1812A Shoring ☒ e. CBC 1813A Ground Improvement ☐ f. ☐ g. ☐ h.

Special Inspections that are in the agency’s scope but are not listed above should be provided in the space(s) below.


☐ a. ☐ b. ☐ c. ☐ d. ☐ e. ☐ f.

9 CONCRETE

Special Inspections


☒ a. CBC 1705/1705A Post-Installed Anchors ☐ b. CBC 1705/1705A Shotcrete

☒ c. CBC 1705/1705A &

ACI 318 Pre-Stressed Concrete ☒ d. CBC 1705/1705A &

ACI 318 Reinforced Cast-In-Place Concrete

☒ e. CBC 1705/1705A & ACI 318

Reinforced Pre-Cast Concrete ☒ f. CBC 1705/1705A and ASTM C94

Batch Plant

☒ g. CBC 1705/1705A &

AWS D1.4 Rebar Welding ☒ h. CBC 1911A & ICC-

ES AC 178 Fiber Reinforced Polymer (FRP) Composites

☐ i.

☐ j.

Special Inspections that are in the agency’s scope but are not listed above should be provided in the space(s) below. Yes Code/Standard Field and Types of Inspection Yes Code/Standard Field and Types of Inspection ☐ a. ☐ b. ☐ c. ☐ d. ☐ e. ☐ f.






10 MASONRY

Special Inspections Yes Code/Standard Field and Types of Inspection Yes Code/Standard Field and Types of Inspection ☒ a.

CBC 1705/1705A & AWS D1.4 Rebar Welding ☒ b. CBC 1705/1705A & TMS

602 Masonry Placement

☐ c. ☐ d.

☐ e. ☐ f.



☒ a. CBC Table 1704.A.4.2 Batch Plant ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.

11 STEEL

Special Inspections


☒ a. CBC 1705/1705A Fireproofing ☒ b. CBC 1705/1705A Structural Cold-Formed Steel

☒ c. CBC 1705/1705A, AISC 360 & 341

High Strength Bolts ☒ d. CBC 1705/1705A, AISC

360 & 341 Steel Fabrication & Erection

☒ e. CBC 1705/1705A,

AWS QC1, AISC 360 & 341

Welding ☐ f.

☐ g. ☐ h.

Special Inspections that are in the agency’s scope but are not listed above should be provided in the space(s) below. Yes Code/Standard Field and Types of Inspection Yes Code/Standard Field and Types of Inspection ☐ a. ☐ b. ☐ c. ☐ d. ☐ e. ☐ f.






12 Wood and Roof Assemblies

Special Inspections


☐ a. CBC 1705/1705A Wood Construction ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.

☐ g. ☐ h.


☐ a. ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.

13 NONSTRUCTURAL COMPONENTS AND MISCELLANEOUS SPECIAL INSPECTIONS

Special Inspections

Yes Code/Standard Field and Types of Yes Code/Standard Field and Types of Inspection

☐ a. CBC 1705/1705A Damping System ☐ b. CBC 1705/1705A Nonstructural Components, Supports and Attachments

☐ c. CBC 1705/1705A Seismic Isolation System ☐ d. CBC 2003 & AWS D1.2 Aluminum/Aluminum Welding

☐ e. CBC 2410 Structural Silicone Glazing (SSG) ☐ f.

Special Inspections that are in the agency’s scope but are not listed above should be provided in the space(s) below. ☐ a. ☐ b.

☐ c. ☐ d.

☐ e. ☐ f.






14 SPECIAL INSPECTORS

Provide Following Information for Each Special Inspector Employed by the Agency (Attach additional sheets if needed)


Inspector’s Name Certification/ License Type



Samuel Carbajal

Concrete ICC 5238717 06-06-21 Prestressed Concrete 06-06-21 Steel & Bolting 07-30-19 Spray Applied Fireproofing 07-16-20

Masonry 07-16-20

Eric Murray

Welding AWS 05030391 03-01-20 Steel & Bolting ICC 5264277 04-13-19 Spray Applied Fireproofing 04-13-19

Steel & Welding 04-13-19

James Allen

Concrete ICC 5288253 03-31-20 Prestressed Concrete 03-31-20 Masonry 03-31-20 Masonry DSA 5765 10-01-20

Joseph Urrete

Concrete ICC 5315548 03-02-20 Spray Applied Fireproofing 03-02-20

Soils 03-02-20 Masonry 03-02-20 Steel & Bolting 03-02-20

Daniel Broyles Welding AWS 06040371 04-21 Building Inspection ICC 5246881 09-24-19 Steel & Welding 09-24-19

Stephen Braun

Welding AWS 18102091 10-01-2021 Concrete ICC 5238503 12-31-19 Prestressed Concrete 12-31-19 Masonry 12-31-19

Darron Bauer Concrete ICC 8024476 12-31-19 Prestressed Concrete 12-31-19 Masonry 12-31-19

Gary Pitonyak Welding AWS 95030391 03-01-19 Concrete ICC 856156 03-14-19 Steel & Welding 03-14-19

Carlos Madrid

Masonry DSA 5553 07-01-22 Class 1 6086 09-06-22 Welding AWS 09020951 02-01-21 Prestressed Concrete ICC 5254676 01-16-20 Concrete 01-16-20 Spray Applied Fireproofing 01-16-20

Masonry 01-16-20 Steel & Welding 01-16-20

Steel & Bolting 01-16-20 Special Inspectors with expired license shall not be permitted to perform Special Inspections.






14 SPECIAL INSPECTORS (Continued)


*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required Fi ld d T f I i




Andrew Molina

Concrete ICC 872318 10-18-19 Masonry 10-18-19 Steel & Welding 10-18-19 Steel & Bolting 10-18-19

John Carr Prestressed Concrete ICC 5029597 06-24-19 Concrete 06-24-19 Masonry 06-24-19

Duc Nguyen Welding AWS 2030071 03-01-20

David Reid Concrete ICC 8138233 12-31-20 Soils 12-31-20

Erik Roed Welding AWS 14010561 01-01-20

Jeffrey Rogers

Concrete ICC 5087272 07-04-20 Masonry 07-04-20 Prestressed Concrete 07-04-20 Spray Applied Fireproofing 07-04-20

Special Inspectors with expired license shall not be permitted to perform Special Inspections.






14 SPECIAL INSPECTORS (Continued)


*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required f



Certification/ License Number

Expiration Date* Comments







15 SUMMARY OF AGENCY’S TESTING AND SPECIAL INSPECTION SERVICES

Structural Tests & Special Inspections (Check all that apply)

Yes

Structural Tests

Yes Structural Special Inspections

☒ Soil ☒ Earthwork

☒ Aggregate ☒ Batch Plant

☒ Reinforcing Steel ☒ Reinforced Concrete

☒ Concrete ☒ Pre-Stressed Concrete

☒ Post-Installed Anchors ☒ Post-Installed Anchors

☐ Concrete Specialty Inserts ☒ Pre-Cast Concrete

☐ Shotcrete ☐ Shotcrete

☒ Masonry ☒ Masonry

☒ Steel ☒ Steel Welding

☒ High-Strength Bolts and other Fasteners ☒ High-Strength Bolts and other Fasteners

☒ Non-Destructive Testing (NDT) ☒ Spray Applied Fireproofing

☐ Wood ☐ Wood

☐ Aluminum/Aluminum Welding ☐ Aluminum/Aluminum Welding

☐ Fiber Reinforced Polymer (FRP) Composites ☒ Fiber Reinforced Polymer (FRP) Composites

☐ Deep Foundations ☒ Deep Foundations

☐ Nonstructural Components, Supports and Attachments ☐ Nonstructural Components, Supports and Attachments

☐ Structural Elements and Connections ☐ Base Isolators

☐ Shake Table Tests ☐ Dampers

Tests and Special Inspections that are in the Agency’s scope but are not listed above should be provided in the space(s) below. ☐ ☐

☐ ☐ ☐ ☐






List of Attachments Supporting the Agency’s Approval (Check all that apply)

Yes Enclosure Type

☒ OSHPD Facilities Development Division (FDD) Payment Form (OSH-AD-367): http://oshpd.ca.gov/FDD/Forms/eSPForms/OSH-FD_367-FacDvmtDivPmtForm.pdf

☒ DSA-LEA Laboratory Qualification as posted at DSA website: https://www.apps.dgs.ca.gov/tracker/ApprovedLabs.aspx

☒ Latest Copy of DSA 100: LEA Program Application as Submitted to DSA

☒ Latest copy of DSA 220: LEA Program On-Site Assessment Report

☒ Latest copy of DSA acceptance (letter) of the Agency into the LEA program.

☒ Current Accreditation Certificate(s) including List of Tests and Special Inspections for which the Agency is Accredited

☒ Copy of Test Technician/Individual Special Inspector’s License/Certification showing expiration date(s)

☒ OPL Number for Conversion of OPL to OPAA only: OPL-0024-15

☒ OPAA Number for Conversion/Renewal of OPAA only: OPAA-0012-16

☐ Other (Please Specify):

☐ Other (Please Specify): ☐ Other (Please Specify): ☐ Other (Please Specify):

OSHPD Approval (For Office Use Only)

Signature: Approval Date: 07-25-2017

Print Name: Jeffrey Kikumoto Approval Expiration Date: 04-25-2021

Title: SSE

Condition of approval (if applicable):





OSH-FD-OPAA-100 (02/21/2020) 7/8/2020 OPAA-0012a-16 Page 1 of 16

7a TEST TECHNICIANS


*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required Field and Types of Inspection Test

Technician’s Name




Expiration Date* Indicate Full Time,

Part Time, or Consultant

Adam Thomas Concrete Field Testing Technician - Grade I

American Concrete Institute

#105465 August 4, 2023 Full Time

Aklilu Estifanos

Concrete Field Testing Technician – Grade I

American Concrete Institute #01077133 September 26, 2020

Full Time Radiation Safety & Use of Nuclear Gauges CPN International 45904 N/A

Angel Camargo Valdez Concrete Field Testing Technician - Grade I

American Concrete Institute #001386445 December 10, 2021 Full Time

Anthony Stewart Concrete Field Testing Technician - Grade I

American Concrete Institute #001057819 February 13, 2021 Full Time

Austin Hill

Aggregate Base Testing Technician

American Concrete Institute #01234231 June 5, 2023

Full Time

Aggregate Testing Technician – Level 2

American Concrete Institute #01234231 December 4, 2023



Concrete Lab Testing Technician – Level 1

American Concrete Institute #01234231 August 16, 2023

Concrete Strength Testing Technician


Cesar Navarro Concrete Field Testing Technician - Grade I

American Concrete Institute #01060439 August 13, 2021 Full Time

Christopher Castaneda Concrete Field Testing Technician - Grade I

American Concrete Institute #01124020 June 29, 2024 Full Time

Christopher Tena Concrete Field Testing Technician - Grade I

American Concrete Institute #01631802 October 13, 2023 Full Time

Christopher Wilson Concrete Field Testing Technician - Grade I


Dale Bartlett Concrete Field Testing Technician - Grade I


Darren Hicks



Full Time

Aggregate Base Testing Technician


Concrete Field Testing Technician - Grade I


Concrete Lab Testing Technician – Level 1










7a TEST TECHNICIANS (Continued)



Technician’s Name






Darron Bauer Concrete Field Testing Technician - Grade I


Donald Smith Concrete Field Testing Technician - Grade I

American Concrete Institute #00986270 April 1, 2022 Full Time

Ismael Gonzalez, Jr. Concrete Field Testing Technician - Grade I


Joseph Kjolsrud



Full Time Radiation Safety and Use of Nuclear Gauges CPN International 44682 N/A

Joseph Urrete


American Concrete Institute #00036795 March 19, 2021

Full Time Nuclear Gauge Operator Training

Pacific Nuclear Technology Co. 13215 N/A

Kristopher Martinez Concrete Field Testing Technician - Grade I


Mario Salazar


American Concrete Institute #01532408 February 23, 2024

Full Time Concrete Strength Testing Technician


Michael Laurenzano Concrete Field Testing Technician - Grade I


Nathan Nolley Concrete Field Testing Technician - Grade I

American Concrete Institute #01646546 June 15, 2024 Full Time

Robert Calderon Concrete Field Testing Technician - Grade I

American Concrete Institute #01539400 May 26, 2023 Full Time

Rocco Brunetti



Part Time Nuclear Gauge Operator Training

Pacific Nuclear Technology Co. 18206 N/A

Roger Jimenez Concrete Field Testing Technician - Grade I


Rolando Miguel Alcaraz Concrete Field Testing Technician - Grade I


Ronald Trebesch Concrete Field Testing Technician - Grade I


Samuel Carbajal













Technician’s Name






Shawn Macias Concrete Field Testing Technician - Grade I


Thomas Morehead Radiation Safety and Use of Nuclear Gauges CPN International 1477 N/A Full Time

Andrew Molina Concrete Field Testing Technician - Grade I


Anthony Wiant


American Concrete Institute #01152494 July 13, 2024


Brad Chitwood




Brande Nolley Concrete Field Testing Technician - Grade I

American Concrete Institute #01542428 July 21, 2023 Full Time

Brett Egan Concrete Field Testing Technician - Grade I

American Concrete Institute #00005754 June 30, 2023 Part Time

Daniel Moa Concrete Field Testing Technician - Grade I

American Concrete Institute #01280749 November 30, 2023 Part Time

David Reid Concrete Field Testing Technician - Grade I


Gary Pitonyak Concrete Field Testing Technician - Grade I

American Concrete Institute #00997822 October 13, 2023 Full Time

Isiah Hall Concrete Field Testing Technician - Grade I

American Concrete Institute #01068542 July 16, 2021 Part Time

John Carr Concrete Field Testing Technician - Grade I


Justin Runge Concrete Field Testing Technician - Grade I


Michael Flowers Radiation Safety and Use of Nuclear Gauges CPN International 40275 N/A Full Time

Michael Geriminsky


American Concrete Institute #01068541 November 21, 2020


Nafez Bachour Concrete Field Testing Technician - Grade I


Raul Tena Concrete Lab Testing Technician - Level I











Technician’s Name






Raul Tena (continued)



Full Time Aggregate Testing Technician – Level 1




Sean Rosenbaum Concrete Field Testing Technician - Grade I


Sheldon Cole Concrete Field Testing Technician - Grade I


Stephen Braun Concrete Field Testing Technician - Grade I


Shawn Tran Concrete Field Testing Technician - Grade I

American Concrete Institute #01229129 February 4,2022 Part Time







14a SPECIAL INSPECTORS


*To update expiration date a renewal application for OPAA and proof of renewal for certification/license shall be required Field and Types of Inspection

Inspector’s Name






Aklilu Estifanos

Full Time

Spray Applied Fire Proofing Spec Insp

International Code Council 5276085 December 5, 2020

Commercial Building Inspector


Prestressed Concrete Special Inspector


Structural Masonry Special Inspector


Reinforced Concrete Special Inspector


Soils Special Inspector International Code Council 5276085 December 5, 2020

Structural Welding Special Inspector


Structural Steel & Bolting Spec Inspector


Master of Special Inspection

International Code Council 5276085 July 15, 2021

Christopher Castaneda Reinforced Concrete Special Inspector

International Code Council 8041223 February 10, 2023 Full Time

Chris Wilson Soils Special Inspector International Code Council 8255489 April 15, 2021 Full Time

Daniel Broyles

Certified Welding Inspector

American Welding Society 06040371 April 2021

Full Time

Structural Steel & Welding Spec Insp

International Code Council 5246881 September 24, 2022

Building Inspector International Code Council 5246881 September 24, 2022

Structural Steel and Bolting Spec Inspector










14a SPECIAL INSPECTORS (Continued)



Inspector’s Name






Darron Bauer

Full Time


International Code Council 8024476 April 26, 2021





Donald Smith

Full Time


International Code Council #1037223 June 21, 2021

Masonry DSA 5237 August 1, 2021

Edwin Rosete

Full Time

Residential Building Inspector

International Code Council 8325989 February 3, 2021




International Code Council 8325989 October 30, 2021

Eric Murray

Full Time






American Welding Society 05030391 March 2023

Ismael Gonzalez, Jr. Soils Special Inspector International Code Council 8033851 August 24, 2021 Full Time










Inspector’s Name






Joseph Kjolsrud


International Code Council 5230739 January 25, 2023

Full Time







Structural Steel & Welding Spec Insp


Joseph Urrete

Full Time


International Code Council 5315548 March 2, 2023







Soils Special Inspector International Code Council 5315548 March 2, 2023

Marcus Weigle


American Welding Society 17091971 September 1, 2023

Part Time

Michael Laurenzano


American Welding Society 17090341 September 1, 2020

Full Time












Inspector’s Name






Michael Laurenzano (continued)

Soils Special Inspector International Code Council 8173152 March 10, 2021

Full Time









Commercial Building Inspector




Robert Calderon


International Code Council 8869530 November 29, 2021

Full Time


International Code Council 8869530 May 21, 2022

Rocco Brunetti



Part Time














Inspector’s Name






Rolando Miguel Alcaraz



Full Time





Structural Masonry Codes


Structural Masonry Plans





International Code Council

5306063 November 4, 2022

Ronald Trebesch

Full Time








American Welding Society 05120541 December 2020

ACCP Level II, MT & UT

The American Society for Nondestructive Testing

139880 August 2023










Inspector’s Name






Samuel Carbajal



Full Time




International Code Council 5238717 June 6, 2021




International Code Council 5238717 August 19, 2022



Prestress Concrete Special Inspector


5238717 June 6, 2021

Alib Sengsone

Full Time







Special Inspector General Requirements


Structural Steel and Bolting Codes


Structural Steel and Bolting Plants



American Welding Society 18078111 July 1, 2021

Andrew Molina

Full Time












Inspector’s Name






Andrew Molina (continued)


International Code Council 872318 July 15, 2021 Full Time

Brett Egan



Part Time Reinforced Concrete Special Inspector




Daniel Moa

Residential Building Inspector


Part Time







David Reid



Full Time Soils Special Inspector International Code Council 8138233 December 31, 2020

Shotcrete DSA 5948 July 19, 2020

Duc Nguyen



Full Time Certified Welding Inspector

American Welding Society 02030071 March 2023

Esteban Rodriguez Certified Welding Inspector

American Welding Society 04080261 August 2022 Part Time










Inspector’s Name






Gary Pitonyak


American Welding Society 95030391 March 1, 2022

Full Time Structural Steel & Welding Spec Inspector




Isiah Hall


American Welding Society 09041301 April 1, 2021

Part Time





Structural Steel & Welding Spec Inspector










Masonry DSA 5319 November 1, 2021

Jeffrey Rogers

Full Time


















Inspector’s Name






John Carr

Full Time







Michael Cannarella



Part Time Reinforced Concrete Special Inspector




Michael Geriminsky



Full Time



Spray-applied Fireproofing Spec Insp




Nafez Bachour

Full Time
















Inspector’s Name






Nafez Bachour (continued)



Full Time



Structural Masonry Plans


Structural Masonry Codes




Paul Grenda


American Welding Society 08091181 September 2020

Part Time

Santos Vargas Certified Welding Inspector

American Welding Society 07031341 March 2022 Part Time

Sheldon Cole


American Welding Society 09041251 April 1, 2021

Part Time









Structural Steel & Welding Spec Inspector

















Inspector’s Name






Stephen Braun

Full Time

Certified Welding Inspector (CWI)

American Welding Society

18102091 October 01, 2021







Thien Nguyen

Part Time


American Welding Society 15111821 November 1, 2021

Spray Applied Proofing Special Inspector






Shawn Tran

Part Time


American Welding Society 12040211 April 2021



8113125 September 1, 2020

Building Plans Examiner


8113125 September 1, 2020

Structural Steel and Bolting


8113125 September 1, 2020










Inspector’s Name






Shawn Tran (continued)

Structural Welding International Code Council

8113125 September 1, 2020

Part Time

Spray Applied Fire Proofing


8113125 September 1, 2020

Building International Code Council

8113125 September 1, 2020



8113125 September 1, 2020

Structural Masonry International Code Council 8113125

September 1, 2020

Commercial Building International Code Council 8113125

September 1, 2020

Prestressed Concrete International Code Council 8113125

June 13, 2021


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